Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD14473 | OR |
NPI | 1003845330 |
---|---|
Provider Name | Edward M Tarbet |
First Address | Bend, OR 97708-6048 |
Second Address | Bend, OR 97701-6051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 26/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00887745 | MEDICARE RAILROAD (01) | OR |
053793 | (05) | OR |
11134767 | CAQH ID (01) | OR |
C94203 | (02) | OR |